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Laser treatment of pilonidal disease: a systematic review

Abstract

Pilonidal disease (PD) is a common condition, and there is still an ongoing debate on ideal management that should be minimally invasive, safe, and efficient. The use of radially emitting laser in the treatment of chronic PD is a novel minimally invasive technique, and initial studies with a small number of patients showed promising results. This study aimed to assess the efficacy and safety of chronic PD treatment with a laser using a systematic review of the published literature. A systematic review was conducted after PubMed, Scopus, Embase, Web of Science, and the Cochrane database search for studies reporting laser treatment of chronic PD. Also, our unpublished prospective single-center study was included in this review. Ten of 87 studies were eligible for the review, including 971 patients. The median age of the patients was 26 (range 13–68), and the median operative time was 26 (range 6–65) min. With a median follow-up of 12 (range 7–25) months, 917 (94.4%) patients achieved primary healing with a weighted mean recurrence rate of 3.8%. The weighted mean complication rate was 10% (95% CI 5.7–14.3%, I2 = 82.28, p < 0.001), and all were minor. The published literature demonstrates that laser treatment is a promising procedure in the management of chronic PD. Furthermore, the review showed that standardized operative techniques and perioperative steps were used. The results were limited to the mild chronic PD. Classification of PD severity and standardized outcome reporting is required to define indications and contraindications for laser PD treatment. Randomized controlled trials are needed to determine the long-term effectiveness and superiority of laser treatment over other methods.

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References

  1. Stauffer VK, Luedi MM, Kauf P et al (2018) Common surgical procedures in pilonidal sinus disease: a meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep 8(1):3058

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Berthier C, Bérard E, Meresse T, Grolleau JL, Herlin C, Chaput B (2019) A comparison of flap reconstruction vs the laying open technique or excision and direct suture for pilonidal sinus disease: a meta-analysis of randomised studies. Int Wound J 16(5):1119–1135

    PubMed  PubMed Central  Google Scholar 

  3. Keshvari A, Keramati MR, Fazeli MS, Kazemeini A, Nouritaromlou MK (2016) Risk factors for complications and recurrence after the Karydakis flap. J Surg Res 204(1):55–60

    PubMed  Google Scholar 

  4. Gavriilidis P, Bota E (2019) Limberg flap versus Karydakis flap for treating pilonidal sinus disease: a systematic review and meta-analysis. Can J Surg 62(2):131–138

    PubMed  PubMed Central  Google Scholar 

  5. Tien T, Athem R, Arulampalam T (2018) Outcomes of endoscopic pilonidal sinus treatment (EPSiT): a systematic review. Tech Coloproctol 22(5):325–331

    CAS  PubMed  Google Scholar 

  6. Handmer M (2012) Sticking to the facts: a systematic review of fibrin glue for pilonidal disease. ANZ J Surg 82(4):221–224

    PubMed  Google Scholar 

  7. Heiskanen V, Hamblin MR (2018) Photobiomodulation: lasers vs. light emitting diodes? Photochem Photobiol Sci 17(8):1003–1017

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Wehner M, Betz P, Aden M (2019) Influence of laser wavelength and beam profile on the coagulation depth in a soft tissue phantom model. Lasers Med Sci 34(2):335–341

    PubMed  Google Scholar 

  9. Parker S (2007) Lasers and soft tissue: ‘loose’ soft tissue surgery. Br Dent J 202(4):185–191

    CAS  PubMed  Google Scholar 

  10. Jain V, Jain A (2012) Use of lasers for the management of refractory cases of hidradenitis suppurativa and pilonidal sinus. J Cutan Aesthet Surg 5(3):190–192

    PubMed  PubMed Central  Google Scholar 

  11. Grubnik VV, Bakhar GA (1993) Primenenie lazera pri khirurgicheskom lechenii épitelial’nogo kopchikovogo khoda [The use of a laser in the surgical treatment of an epithelial coccygeal cyst]. Klin Khir 1:23–25

    Google Scholar 

  12. Klin B, Heller ON, Kaplan I (1990) The use of the CO2 laser in pilonidal sinus disease: preliminary results of an ambulatory prospective study. J Clin Laser Med Surg 8(1):31–37

    CAS  PubMed  Google Scholar 

  13. Doll D, Luedi MM (2017) Laser may reduce recurrence rate in pilonidal sinus disease by reducing captured occipital hair. Lasers Med Sci 32(2):481–482

    PubMed  Google Scholar 

  14. Lindholt-Jensen CS, Lindholt JS, Beyer M, Lindholt JS (2012) Nd-YAG laser treatment of primary and recurrent pilonidal sinus. Lasers Med Sci 27(2):505–508

    PubMed  Google Scholar 

  15. Brehmer F, Zutt M, Lockmann A, Schön MP, Thoms KM (2013) Nd:YAG laser epilation to prevent recurrences after pilonidal sinus surgery. J Dtsch Dermatol Ges 11(12):1203–1205

    PubMed  Google Scholar 

  16. Dessily M, Charara F, Ralea S, Allé JL (2017) Pilonidal sinus destruction with a radial laser probe: technique and first Belgian experience. Acta Chir Belg 117(3):164–168

    PubMed  Google Scholar 

  17. Georgiou GK (2018) Outpatient laser treatment of primary pilonidal disease: the PiLaT technique. Tech Coloproctol 22(10):773–778

    PubMed  Google Scholar 

  18. Pappas AF, Christodoulou DK (2018) A new minimally invasive treatment of pilonidal sinus disease with the use of a diode laser: a prospective large series of patients. Colorectal Dis 20(8):O207–O214

    CAS  PubMed  Google Scholar 

  19. Dessily M, Dziubeck M, Chahidi E, Simonelli V (2019) The SiLaC procedure for pilonidal sinus disease: long-term outcomes of a single institution prospective study. Tech Coloproctol 23(12):1133–1140

    CAS  PubMed  Google Scholar 

  20. Harju J, Söderlund F, Yrjönen A, Santos A, Hermunen K (2020) Pilonidal disease treatment by radial laser surgery (FilaC™): the first Finnish experience (published online ahead of print, 2020 Dec 21). Scand J Surg 1457496920975610

  21. Porwal A, Gandhi P, Kulkarni D (2020) Laser pilonidotomy — a new approach in management of complex pilonidal sinus disease: an exploratory study. J Coloproctol 40(01):024–030

    Google Scholar 

  22. Allam H, Anwar H, Essa K (2020) Uses of laser therapy in management of pilonidal sinus. Al-Azhar Int Med J 1(2):26–31

    Google Scholar 

  23. Yardimci VH (2020) Outcomes of two treatments for uncomplicated pilonidal sinus disease: Karydakis flap procedure and sinus tract ablation procedure using a 1,470 nm diode laser combined with pit excision. Lasers Surg Med 52(9):848–854

    PubMed  Google Scholar 

  24. Khubezov DA, Lukanin RV, Krotkov AR, Ogoreltsev AY, Serebryansky PV, Yudina EA (2020) Laser ablation for pilonidal disease. Koloproktologia 19(2):91–103

    Google Scholar 

  25. Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 372:n71

    PubMed  PubMed Central  Google Scholar 

  26. National Institute for Health and Clinical Excellence (2019) https://www.nice.org.uk/guidance/cg3/documents/appendix-4-qualityof-case-series-form2. Accessed 22 Jan 2021

  27. Karahaliloglu A (2007) First results after laser obliteration of first- and second-degree hemorrhoids. Coloproctology 29:327–336

    Google Scholar 

  28. Plapler H, Hage R, Duarte J, Lopes N, Masson I, Cazarini C et al (2009) A new method for hemorrhoid surgery: intrahemorrhoidal diode laser, does it work? Photomed Laser Surg 27(5):819–823

    PubMed  Google Scholar 

  29. Naderan M, Shoar S, Nazari M, Elsayed A, Mahmoodzadeh H, Khorgami Z (2017) A randomized controlled trial comparing laser intra-hemorrhoidal coagulation and Milligan-Morgan hemorrhoidectomy. J Investig Surg Off J Acad Surg Res 30(5):325–331

    Google Scholar 

  30. Longchamp G, Liot E, Meyer J et al (2021) Non-excisional laser therapies for hemorrhoidal disease: a systematic review of the literature. Lasers Med Sci 36:485–496

    PubMed  Google Scholar 

  31. Giamundo P, Salfi R, Geraci M, Tibaldi L, Murru L, Valente M (2011) The hemorrhoid laser procedure technique vs rubber band ligation: a randomized trial comparing 2 mini-invasive treatments for second- and third-degree hemorrhoids. Dis Colon Rectum 54(6):693–698

    PubMed  Google Scholar 

  32. Maloku H, Gashi Z, Lazovic R, Islami H, Juniku-Shkololli A (2014) Laser hemorrhoidoplasty procedure vs open surgical hemorrhoidectomy: a trial comparing 2 treatments for hemorrhoids of third and fourth degree. Acta Inform Med 22(6):365–367

    PubMed  PubMed Central  Google Scholar 

  33. Faes S, Pratsinis M, Hasler-Gehrer S, Keerl A, Nocito A (2019) Short- and long-term outcomes of laser haemorrhoidoplasty for grade II-III haemorrhoidal disease. Colorectal Dis 21(6):689–696

    CAS  PubMed  Google Scholar 

  34. Brusciano L, Gambardella C, Terracciano G, Gualtieri G, Schiano di Visconte M, Tolone S, Del Genio G, Docimo L (2020) Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoidoplasty, a minimal invasive treatment of symptomatic hemorrhoids. Updates Surg 72(3):851–857

    PubMed  Google Scholar 

  35. Wilhelm A (2011) A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe. Tech Coloproctol 15(4):445–449

    CAS  PubMed  Google Scholar 

  36. Giamundo P, Geraci M, Tibaldi L, Valente M (2014) Closure of fistula-in-ano with laser—FiLaCTM: an effective novel sphincter-saving procedure for complex disease. Colorectal Dis 16(2):110–115

    CAS  PubMed  Google Scholar 

  37. Terzi MC, Agalar C, Habip S, Canda AE, Arslan NC, Obuz F (2018) Closing perianal fistulas using a laser: long-term results in 103 patients. Dis Colon Rectum 61(5):599–603

    PubMed  Google Scholar 

  38. Adegbola SO, Sahnan K, Pellino G et al (2017) Short-term efficacy and safety of three novel sphincter-sparing techniques for anal fistulae: a systematic review. Tech Coloproctol 21(10):775–782

    CAS  PubMed  Google Scholar 

  39. Kalaiselvan R, Bathla S, Allen W, Liyanage A, Rajaganeshan R (2019) Minimally invasive techniques in the management of pilonidal disease. Int J Colorectal Dis 34(4):561–568

    PubMed  Google Scholar 

  40. Lund J, Tou S, Doleman B, Williams JP (2017) Fibrin glue for pilonidal sinus disease. Cochrane Database Syst Rev 1(1):CD011923

    PubMed  Google Scholar 

  41. Bi S, Sun K, Chen S, Gu J (2020) Surgical procedures in the pilonidal sinus disease: a systematic review and network meta-analysis. Sci Rep 10(1):13720

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Sharma D, Pratap A, Ghosh A, Shukla VK (2009) Malignant transformation of a pilonidal sinus. Surgery 145(2):243–244

    PubMed  Google Scholar 

  43. Beal EM, Lee MJ, Hind D, Wysocki AP, Yang F, Brown SR (2019) A systematic review of classification systems for pilonidal sinus. Tech Coloproctol 23(5):435–443

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Keshvari A, Keramati MR, Fazeli MS, Kazemeini A, Meysamie A, Nouritaromlou MK (2015) Karydakis flap versus excision-only technique in pilonidal disease. J Surg Res 198(1):260–266

    PubMed  Google Scholar 

  45. Saber A (2014) Modified off-midline closure of pilonidal sinus disease. N Am J Med Sci 6(5):210–214

    PubMed  PubMed Central  Google Scholar 

  46. Brusciano L, Del Genio G, Tolone S, Schiano di Visconte M, Gualtieri G, Terracciano G, Gambardella C, Docimo L (2019) D-shape asymmetric excision in recurrent pilonidalis disease: an analytic longitudinal long-term evaluation. Updates Surg 71(4):723–727

    PubMed  Google Scholar 

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I.R. designed the study. G.A. and T.B. participated in data extraction, analysis, and writing of the manuscript. B.B. and T.M critically revised the manuscript and statistical results. All authors approved the manuscript and this submission.

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Correspondence to Ivan Romic.

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Romic, I., Augustin, G., Bogdanic, B. et al. Laser treatment of pilonidal disease: a systematic review. Lasers Med Sci 37, 723–732 (2022). https://doi.org/10.1007/s10103-021-03379-x

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  • DOI: https://doi.org/10.1007/s10103-021-03379-x

Keywords

  • Pilonidal disease
  • Laser
  • Recurrence
  • Outcome
  • Systematic review